WND, R (on the application of) v NHS West and North London Integrated Care Board

An NHS integrated care board’s assessment of a disabled child’s continuing-care package involves evaluative judgments, but it must engage rationally with clear and material clinical evidence. A Decision Support Tool is not a substitute for evidence-based professional judgment. A multi-disciplinary panel’s expertise and the volume of material before it do not cure a failure to address a central professional recommendation. Where a panel rejected the tool’s recommendation but failed to confront a report recommending 24/7 nursing care, its refusal to provide that level of care was outside the range of reasonable responses and irrational in both process and outcome. The decision was quashed.

The claimant, a 13-year-old child with complex medical disabilities and seizures, received NHS continuing care from the defendant Integrated Care Board. The package provided 126 hours of weekly support at a 2:1 ratio, including nine hours of nursing care daily, but did not provide 24/7 care. The claimant sought judicial review of the panel’s decision of 28 January 2026 not to provide 24/7 care, alleging process and outcome irrationality in the treatment of the Decision Support Tool and clinical evidence. The central issues were whether the decision was irrational and whether a review or complaints process was an adequate alternative remedy. The London Borough of Haringey took no part.

1. Disposition. The claim was allowed and the defendant’s decision of 28 January 2026 not to provide 24/7 care was quashed. The court declined to impose a mandatory order requiring that level of care.
2. Standard of review. Section 3 of the National Health Service Act 2006 and regulation 21 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 provided the statutory framework. Applying R (Simpson) v NHS Mid and South Essex ICB [2024] EWHC 3063 and R (Wahid) v Tower Hamlets LBC [2002] EWCA Civ 287, the court treated the ICB’s assessment as an evaluative judgment subject to supervisory, not substitutionary, review. The court considered process rationality, outcome rationality, reasonable inquiry, and the need to balance close scrutiny with respect for the primary decision-maker’s functional role.
3. Decision Support Tool and evidence. The Decision Support Tool was an aid to assessment, not a prescriptive answer. The panel had to exercise evidence-based professional judgment and engage with the wider clinical evidence. The report of Ms Hassall, the care provider’s clinical lead, clearly recommended 24/7 nursing care. The court rejected the defendant’s narrow interpretation of the report as relating only to commissioned hours or seizure risk. It addressed feeding, hydration, bowel management, mobility and behavioural escalation, all requiring nursing-level judgment.
4. Irrationality. Although the panel was multi-disciplinary and had detailed evidence, it was illogical to disregard or materially misinterpret the report. The failure to grasp the central issue involved both a recognised process error and an outcome outside the range of reasonable responses. The court therefore found the decision irrational.
5. Alternative remedy. The court distinguished R (GVH) v Leicester, Leicestershire and Rutland ICB [2026] EWHC 1016, where a complaints mechanism had been treated as a suitable alternative remedy. The parents had lost confidence in the review process because the defendant had not provided the disclosure or assurances of independence sought. The claimant was not required to continue that process.
6. Relief. The court declined to prescribe the composition of a new panel or impose a timetable. The matter was to be reconsidered expeditiously, without a court-imposed deadline, subject to any further judicial review.